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Piroxicam (NSAID, analgesic/pain reliever)

Uses|Precautions & warnings|Side effects|Interactions|Dosage

Piroxicam is part of a class of drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs), specifically a non-selective cyclooxygenase (COX) inhibitor. NSAIDs are treat various causes of pain, inflammation, and swelling. It also reduces fever.

COX inhibitors work by blocking the action of either or both the COX-1 and COX-2 enzymes. These enzymes are responsible for converting arachidonic acid into prostaglandin, which is a group of substances that regulate many cellular processes such as platelet aggregation, vasodilation, gastric mucus secretion, and proinflammatory mediators.

piroxicam

Uses

What is piroxicam used for?

  • Ankylosing spondylitis
  • Osteoarthritis
  • Rheumatoid arthritis
  • Pain and inflammation

How should I take piroxicam?

Piroxicam is available as an oral capsule, tablet, topical gel, and transdermal patch. The oral capsule and tablet should be taken by mouth without chewing or crushing it. The tablets should be taken with food to prevent gastric irritation.

The topical gel should be applied as an even layer on the affected areas several times a day, as directed by your doctor. The transdermal patch should be applied to clean, dry, and hairless skin. Avoid applying it near the eye or on broken skin.

How do I store piroxicam?

This product is best stored at controlled room temperature away from direct light and moisture. To prevent drug damage, you should not store it in the bathroom or the freezer.

There may be different brands of this drug that may have different storage needs. So, it is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush this product down the toilet or pour them into a drain unless instructed to do so. Additionally, it is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using piroxicam?

Before using this drug, tell your doctor if you are/have:

  • Pregnant or breastfeeding.
  • Taking any other medicines, especially other NSAIDs. This includes any prescription, OTC, and herbal remedies.
  • An allergy to any of the ingredients of this product or other NSAIDs.
  • Any other illnesses, disorders, or medical conditions, especially:
    • Asthma
    • Bleeding disorders
    • Cardiovascular disease
    • PUD or GERD
    • Inflammatory bowel disease
    • Upcoming surgery or dental procedures

Is it safe during pregnancy or breastfeeding?

Avoid using this drug while pregnant. It is contraindicated (not allowed) during the 3rd trimester. Please always consult with your doctor to weigh the potential benefits and risks before taking any medication.

This drug may be excreted in breast milk. This drug should be used while breastfeeding only if the potential benefit justifies the potential risk to the child, as determined by your doctor.

Side effects

What side effects can occur when using piroxicam?

Like all drugs, this product may have side effects. If they occur, side effects are generally mild and resolve once treatment is finished or the dose is lowered. Some reported side effects include:

  • Nausea
  • Diarrhea
  • Stomach upset
  • Abdominal pain
  • Indigestion
  • Headache
  • Dizziness
  • Allergic reaction
  • Bronchospasm
  • Blood abnormalities
  • Edema
  • Eye irritation
  • Photosensitivity
  • Malaise
  • Tinnitus
  • Drowsiness **Do not take before driving or operating machinery

Seek medical attention immediately if you experience any of these serious, potentially fatal drug reactions:

  • Arterial thrombotic events (e.g. stroke, heart attack)
  • Gastrointestinal damage or bleeding
  • Severe hypersensitivity reaction
  • Hepatitis
  • Nephrotoxicity
  • Hematologic abnormalities (e.g. anemia)
  • Seizures

However, not everyone experiences these side effects. In addition, some people may experience other side effects. So, if you have any concerns about a side effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with piroxicam?

This medication may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects.

To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs, and herbal products) and share it with your doctor and pharmacist.

Drugs with known interactions:

  • Other NSAIDs
  • Salicylates
  • Anticoagulants
  • Cyclosporine
  • Corticosteroids
  • Quinolones
  • Lithium
  • Diuretics
  • Methotrexate
  • Antihypertensives
  • Selective serotonin reuptake inhibitors (SSRIs)

If you experience an adverse drug interaction, stop taking this drug and continue taking your other medication. Inform your doctor immediately to reevaluate your treatment plan. Approaches include dose adjustment, drug substitution, or ending therapy.

Does food or alcohol interact with piroxicam?

The absorption rate is slightly decreased with food, however, taking it with a meal prevents gastrointestinal distress. This drug should not be taken with alcohol as it may increase the risk of gastrointestinal ulceration, bleeding, and hepatotoxicity.

What health conditions may interact with piroxicam?

This drug may interact with underlying conditions. This interaction may worsen your health condition or alter the way the drug works. Therefore, it is important to always let your doctor and pharmacist know all the health conditions you currently have, especially:

  • Active bronchial asthma
  • Uncontrolled hypertension
  • Congestive heart failure (CHF)
  • Other cardiovascular diseases
  • Gastrointestinal diseases
    • Peptic ulcer disease (PUD)
    • Gastroesophageal reflux disease (GERD)
  • Conditions that require surgery
  • Renal or hepatic impairment
  • Women with fertility issues or are undergoing treatment
  • Elderly patients over the age of 60
  • CYP2C9 poor metabolizers

Inform your doctor or pharmacist if you have any concerns regarding specific health conditions.

Dosage

The information provided is not a substitute for any medical advice. Therefore, you should always consult with your doctor or pharmacist before using any medication.

What is the dose for an adult?

Oral dosage forms: take 20 mg per day as a single dose or divided doses. Use the lowest effective dose for the shortest duration, not exceeding 14 days.

Topical dosage forms: apply a thin layer to the affected areas 3 to 4 times per day. Use for up to 4 weeks, or as directed by your doctor.

What is the dose for a child?

There is no established pediatric dose. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is piroxicam available?

Piroxicam is available in the following dosage forms and strengths:

  • Oral capsule or tablet: 10 mg, 20 mg
  • Topical gel: 0.5% w/w

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to the nearest emergency room.

What should I do if I miss a dose?

If you miss a dose, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Piroxicam https://www.mims.com/philippines/drug/info/piroxicam/?type=brief&mtype=generic Accessed June 16, 2021

Piroxicam capsules https://my.clevelandclinic.org/health/drugs/18783-piroxicam-capsules Accessed June 16, 2021

Piroxicam (Oral Route) https://www.mayoclinic.org/drugs-supplements/piroxicam-oral-route/description/drg-20069771 Accessed June 16, 2021

Piroxicam https://www.arthritis.org/drug-guide/nsaids/piroxicam Accessed June 16, 2021

Piroxicam (Systemic). Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed June 16, 2021. http://online.lexi.com

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Written by Stephanie Nicole Nera, RPh, PharmD Updated Jun 16
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